Study looks at menopause, cognitive function in women of color, including women with HIV

The odds of impairment in learning, memory and attention/working memory were all significantly increased during the menopause transition, according to a study led by University of Illinois Chicago professor Pauline Maki in the journal Menopause. Although measurable declines in these areas were common as women transitioned through menopause, only a small percentage of women showed clinically significant declines in these cognitive functions.  

The good news for women with HIV is that they appear to be no more vulnerable to menopause-related cognitive declines compared with other women, according to the paper, “Cognitive changes during the menopausal transition: a longitudinal study in women with and without HIV.” 

Maki, a professor of psychiatry, psychology and ob/gyn, sought to discover if low-income women of color and/or women with cognitive vulnerabilities, such as those with HIV, experience higher-than-expected cognitive difficulties during menopause. 

“When people think about menopause, they think about hot flashes. Most people aren’t aware of menopause’s effects of cognition, mood and other psychological effects,” Maki said. “We wanted to quantify those symptoms in women, and we were interested in asking these questions in the population UIC serves — low income, urban-dwelling women and women of color.” 

Many women fear that the memory changes they experience are an early sign of Alzheimer’s disease or HIV-related cognitive impairment, according to Maki. 

“We wanted to see if women with HIV are even more vulnerable to cognitive symptoms related to menopause and thankfully, they are not,” Maki said. “ 

The study analyzed 443 women — median age 42 — from the Women’s Interagency HIV Study, of whom 34% were women without HIV, 69% Black and 18% Hispanic. 

All the women completed baseline testing for verbal learning and memory, attention/working memory, processing speed, verbal fluency, motor skills and executive function by fall 2008, then had two or more follow-up office visits spaced two years apart. All women were premenopausal at the baseline assessment. 

“For memory, there was two-fold increased odds of impairment during the transition from pre- to early menopause, but that resolved in the postmenopausal stage,” Maki said. “For learning, there was a two- to three-fold increased odds of impairment that was sustained across the menopause transition into the post menopause.” 

A similar pattern was observed for attention/working memory. 

“While the majority of women did not experience a clinically significant menopause-related decline in learning and memory, up to 11% of women showed a clinically significant worsening of cognitive performance associated with the menopause transition,” Maki said. 

Despite other studies showing that the average performance on cognitive tests of learning and memory worsens as women transition through menopause, Maki’s study is the first to determine what percent of women showed worsening of cognitive performance that reached the threshold of impairment. 

 “I was surprised that this was observed for about 1 in 10 women. I was also surprised that there was no difference between women with HIV and those without HIV in cognition changes across the menopause,” Maki said. 

Maki said clinicians should help to normalize the cognitive complaints of women.  

“Evidence-based approaches for sustaining brain health include exercise, Mediterranean diet, sleep hygiene and novel cognitive activities,” Maki said. “We also need to know who is most vulnerable to cognitive impairment associated with menopause.” 

The study’s other authors are Gayle Springer, Johns Hopkins, Baltimore, Maryland; Kathryn Anastos, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York; Deborah Gustafson, SUNY-Downstate Medical Center, Brooklyn, New York; Kathleen Weber, Cook County Health and Hospitals System and Hektoen Institute of Medicine, Chicago; David Vance, University of Alabama at Birmingham, Alabama; Dr. Derek Dykxhoorn, University of Miami, Coral Gables, Florida; Joel Milam, University of Southern California, Los Angeles, California; Adaora A Adimora, University of North Carolina, Chapel Hill, North Carolina; Dr. Seble G Kassaye, Georgetown University, Washington, D.C.; Drenna Waldrop, Emory University, Atlanta, Georgia, and Leah Rubin, Johns Hopkins University.